PSYCHOTHERAPY IN FORENSIC SETTINGS AND SPECIAL CHALLENGES

<< PSYCHOTHERAPIES IN FORENSIC SETTINGS:Avoiding reactance, Externalization

FORENSIC PSYCHOTHERAPY:Exploring therapeutic alliance, Music Therapy >>

Forensic Psychology (PSY - 513)

Lesson 35

PSYCHOTHERAPY IN FORENSIC SETTINGS AND SPECIAL CHALLENGES

Objectives

To understand the importance of limit setting in forensic settings

To address the issue of confidentiality in legal setting

The equal balance of boundaries limits and rights of therapists in both forensic and non forensic

psychotherapy is important. But importance becomes more vital because a forensic psychotherapist is

not just a therapist who works with "difficult" cases. Trainees need to be familiar with all aspects of

forensic practice to understand the complex and often difficult environments in which they (and their

colleagues) have to work. They need to have a clear and practical understanding of what it is their

forensic psychologist colleagues have to do, so their input can be integrated with other aspects of

planning treatment. Equally, forensic psychotherapy is more than just talking to forensic patients.

Balancing empathy with limit setting

While working in forensic /legal settings a therapist encounter the challenge of limit setting and they

ought to remember a word of caution that respect should be two way process. An offender who is

habitual of breaking limits and exploiting other people will definitely try to exploit and will move

beyond set limits. Usually zeal of humanistic therapists ignores the importance of these limits. But a

Balance of empathy, positive regard, compliments, positivity with boundaries, ethical conduct and

firmness is the core idea of therapeutic alliance.

Issue of limit setting has crucial elemental importance in therapeutic process. Therapist has to observe

and create the balance between empathy and limit settings with firmness and consistency. Respect,

dignity and safety of therapist are equally important.

What do we mean by boundaries?

Boundaries can be time related, space related and other psychological limits also include in this

category. And breeching code of conduct is neither beneficial for therapeutic process nor for the client

as in forensic setting a therapist is basically trying to help offenders learn and respect boundaries and

rules, by violating limits a therapist is not helping in right direction and creating disruption in

therapeutic process, infact teaching and reinforcing the breakage of boundaries. Boundaries can be

following types:

Temporal boundaries

Physical boundaries

Psychological boundaries

Professional way of boundary setting

A forensic therapist can enforce limits in following ways:

Not granting extra time, ending session with in time and not extending the session.

Not promising privileges like extra TV watching time e.t.c

Not seeing out of turn or taking a client in extra slot

Not visiting outside professional locations, like if a client asks to meet in Mc Donald'

or try to talk in corridors. Some time it is not safe to view clients outside the

professional/forensic setting.

Safety concerns

What forensic patients have done and are capable of doing must never be forgotten. However, in

secure environments the availability of nursing staff or guards to maintain a watchful presence,

122

Forensic Psychology (PSY - 513)

together with physical security aids such as emergency buttons and personal alarms, protect forensic

psychotherapists when seeing patients. In non-secure environments, the task of the forensic

psychotherapist can be made more difficult when there is poor-quality or ambiguous information

about the patient's behaviour between therapy sessions. In these settings, the forensic

psychotherapist must more frequently assess whether the total treatment available has been enough

to prevent destructive acting out.

For Therapist's safety, therapist needs to have control over therapy room and seating

arrangements should not block the way out. Particularly client should not be placed in between

outside door and therapist.

Safety of client is also very important, like a client tells that he/she is going to commit suicide.

Facing such situation what a therapist should do? How to respect the issue of confidentiality?

How to maintain Confidentiality in forensic settings

Forensic psychotherapists are often involved in multi-disciplinary, interagency and medico-legal

work as well as working in settings such as prisons, where they have dual obligations both to their

patients and to their employing authority. Such situations can give rise to conflict with respect to

confidentiality.

To address confidentiality is more important in forensic settings then non forensic settings, because

therapist frequently encounter the clients claiming to possess the weapons with intentions to kill the

co-prisoners. Many times therapist faces the dilemma of client's safety and confidentiality

(planning for suicide) or society's safety and confidentiality (plan of some violent act like murder)

e.g a client has a plan to murder his co prisoner, in this situation therapist has two challenges:

Therapist is to use the therapeutic space and convince the client for not practicing that

hideous job and handover the weapon to the prison staff.

And even after that if therapist is doubtful then it is his responsibility to break the

confidentiality because this is a serious threat to some one's life.

Take another example of a child who has been abused by his uncle, now considering the matter of

confidentiality a therapist will not break the trust of that child but rather will try to boost the confidence

and self esteem of child to inform his parents about the hideous activities of his uncle. Although at first

it is quite difficult for the child, so child is convinced to resist the forlorn stay with uncle.

So in short breaking confidentiality should be the last resort to any problem.

Observing boundaries

It is therapist's duty to observe the boundaries and create a balance.

1. Not a good idea to use client's services outside of professional relationship like fixing a car

engine. By doing this therapist is creating another new boundary and may not be able to enforce

other limits.

2. Therapist should not establish any friendship with client.

3. No gifts should be taken from clients. Infact this boundary should be cleared to client at the start

of the therapeutic relationship.

4. Dual relationships

Therapist should avoid following types of relationships with clients:

5. Any sexual relationship whether it is marital or out of this context. Therapist should understand

their own boundaries and limits and this rule is also applied to x-clients. Research evidences

supports the notion that because of the phenomenon of Transference (Parent like relationship)

a client who enters sexual relationships whether in marriage or out of it, have effects that are

usually experienced by victims of incest.

123

Forensic Psychology (PSY - 513)

6. No business dealings

In limit setting a forensic therapist is suppose to:

Impose and enforce boundaries for clients.

Setting boundaries for self

Making those boundaries clear to the client as adherent to therapeutic process.

124

Table of Contents: